DOCX

ULTRASOUND RESIDENT ROTATION

By Alice Reynolds,2014-08-09 18:27
9 views 0
ULTRASOUND RESIDENT ROTATION

    Louisiana State University Health Sciences Center

    Shreveport Radiology Residency Program

    Ultrasound Curriculum, Goals and Objectives

Hours: 7:30 a.m. 4:00 p.m.

Duties and Expectations:

    Welcome to the Ultrasound service. During your rotation through Ultrasound, you will obtain both skill and confidence in performing and interpreting Ultrasound examinations. You should get as much hands on experience performing the examinations as reasonably allowable, considering time constraints, number of patients, etc. We encourage you to be in the room with the ultrasound technologist as frequently as possible to further enhance your learning of ultrasound and to better provide care for the patients.

    Your day begins with the 7:30 am conference. Following this conference, you should report to the ultrasound reading room. At that point, the examinations performed the previous evening/overnight should be reviewed. These should have a preliminary report provided by the resident on call. You will pick up these preliminary reports from the US Box in the Dept. Office. These examinations should be reviewed with the attending faculty assigned that day and then dictated. The schedule of examinations for the day should be reviewed with the sonographers and any protocol questions discussed with faculty. At noon, you will attend the daily noon conference. You will be given time off before to get your lunch. Following the conference, you should return to the ultrasound reading room and check in with the ultrasound technologists to check on the afternoon schedule and for any emergency examinations performed over the lunch/conference hour or any upcoming studies.

    If you are new to Ultrasound, you need to spend time observing the sonographers performing examinations initially and later gain more scanning experience yourself. The general flow through this section is as follows:

    a. The sonographers (or residents) perform an examination.

    b. The sonographers send images to the PACS.

    c. The images are reviewed by the resident and/or staff member, when possible.

    d. The physician then scans any areas in question, based on the sonographers’

    images, to complete the examination. (as requested by sonographers)

    e. The mornings are generally reserved for scanning and the afternoons are for

    reading.

    We have ongoing readout case-by-case throughout the day. You will dictate examinations with which you are involved. Because you need experience scanning as well as interpreting, you will be involved in different cases at different levels.

    If this is your initial experience in ultrasound, you should concentrate on developing technical and interpretive skills for the ultrasound examinations that are most commonly requested on an emergent basis. This includes pelvic ultrasound (especially with a question of early intrauterine pregnancy or ectopic pregnancy), gallbladder/biliary ultrasound, and renal ultrasound. You should also attempt to learn the technique for evaluation of the lower extremities for deep venous thrombosis. After mastering the above, broaden the scope of ultrasound examinations with which you are involved. On your second Ultrasound rotation, you should become involved in the full spectrum of exams performed in the Ultrasound section.

    Scanning is primarily done by the sonographers. It is your responsibility to assist them as needed to complete the exam. On call exams are done by the sonographers as well. However, it is important that you develop technical skills in scanning. You are expected to go in on any exams requested by technologists. Charts are available at the US desk on all inpatients. ER exams are done in the ER. Pediatric exams are the responsibility of the Pediatric service. The US resident is expected to assist as needed. It is the responsibility of Pediatrics to inform US if coverage is needed.

    Keep in mind that on a day-to-day basis, you can learn a great deal from the sonographers, as well as from faculty.

    Patient Care

    FIRST YEAR RESIDENTS (PGY-2):

    1. A basic understanding of the choice of appropriate equipment for a

    given examination should be obtained. This includes knowledge of

    advantages and disadvantages of sector versus linear transducers.

    The relationship of transducer frequency to depth penetration and

    resolution should be understood. The effect of simple manipulations of

    controls on the machine should be understood. This includes

    adjustment of gain, time gain compensation curves, power output

    adjustment, level of electronic focus of transducer beam, depth of field,

    and Doppler controls.

    2. The resident should achieve basic competence in performing

    ultrasound evaluation of the gallbladder and bile ducts, kidneys, female

    pelvis, and veins of the lower extremities. This includes endovaginal

    examination of the pelvis for questioned gynecological pathology or

    questioned ectopic pregancy. The resident should be familiar with

    ACR guidelines for abdominal and pelvic examinations.

    3. The resident should become comfortable with interpretation of images

    generated by sonographers in the area of the abdomen and pelvis.

    This especially includes evaluation of the gallbladder and bile ducts,

    kidneys, and the female pelvis.

    4. Demonstrate knowledge of and ability to use electronic patient

    information systems, including the radiology information system and

    appropriate use of electronic systems to obtain patient laboratory data,

    etc., to integrate with imaging findings to assist in an accurate

    diagnosis.

    5. Understand the indications for each imaging examination performed

    and the specific indications for any examination performed on an

    individual patient. Perform exams responsibly and safely, assuring

    that the correct exam is ordered and performed.

    6. Demonstrate the ability to use the internet as a tool for teaching and

    learning, including access to information to improve knowledge in

    patient care situations.

    SECOND AND THIRD YEAR RESIDENTS (PGY-3 or 4):

    1. All of the objectives listed for first year residents should be reviewed

    with increased mastery.

    2. Demonstrate ability to integrate laboratory findings and other clinical

    parameters in recommending appropriate patient specific imaging

    strategies for diagnostic purposes.

    3. Increase experience with the performance and interpretation of less

    common ultrasound examinations, including small parts (thyroid,

    scrotum, etc.).

    4. The principles of Doppler ultrasound and its application to vascular

    studies should be understood. The ability to perform venous

    ultrasounds should be extended from applications limited to the lower

    extremities to other veins of the body.

    5. Basic understanding of the application of ultrasound guidance to

    invasive procedures should be obtained. This should include an

    understanding of the approach to fluid aspirations and soft tissue

    biopsies including the thyroid.

    ndrd6. All 2 and 3 trimester OB exams should be reviewed by the resident,

    but we do relatively few of these exams. We will try to allow you some ndrdtime to observe OB exams in your 2 and 3 year rotations. (Wed.

    am will be set aside for special exams)

    7. The resident should become a resource to medical students and junior

    residents in achieving the above objectives.

    FOURTH YEAR RESIDENTS (PGY-5):

    1. All of the objectives listed for first, second, and third year residents

    should be reviewed with increased mastery.

    2. Teaching of the above objectives to medical students and junior

    residents should be increasingly emphasized.

    Medical Knowledge

    FIRST YEAR RESIDENTS (PGY-2):

    1. Normal sonographic anatomy of the abdomen and pelvis should be

    mastered along with knowledge of the effects of common pathologies

    of this anatomy. This includes cholelithiasis and cholecystitis, biliary

    obstruction, hydronephrosis, cystic renal disease, and common

    pathologies in the female pelvis. Particular emphasis should be placed

    on evaluation of early normal and abnormal intrauterine pregnancy,

    ectopic pregnancy, and alterations in the adnexa accompanying pelvic

    inflammatory disease and pelvic neoplasms.

    SECOND AND THIRD YEAR RESIDENTS (PGY-3 or 4):

     1. All of the objectives listed for first year residents should be reviewed

    with increased mastery.

    2. Knowledge of the application of Doppler ultrasound should be

    broadened. This should include Carotid Doppler exams and Doppler

    exams of abdominal organs, especially the liver. Alterations in hepatic

    gray scale and Doppler related to cirrhosis and portal hypertension

    should be mastered. The significance of wave form alteration in

    interpreting carotid ultrasound should be understood. Methods of

    quantifying Doppler signals should be learned.

    3. Demonstration of the knowledge associated with first and second year

    objectives (in this document and rotation specific objectives) should be

    demonstrated with teaching to medical students and junior residents.

    4. Increased attention to MSK and OB US may be allowed as practical on

    Wednesdays and Fridays.

    FOURTH YEAR RESIDENTS (PGY-5):

    1. All of the objectives listed for first, second, and third year residents

    should be reviewed with increased mastery.

    2. Increased proficiency in performance and interpretation of obstetrical

    ultrasound should be demonstrated, especially during your one month

    OB Ultrasound elective with the High-Risk OB section. Knowledge of

    common abnormalities, including neural tube defects, abdominal wall

    abnormalities, GI obstructions, and GU obstructions should be

    demonstrated. Knowledge and understanding of the pathologies

    causing and associated with oligohydramnios and polyhydramnios

    should be mastered. The ability to identify different types of twin

    pregnancies sonographically should be demonstrated.

    3. Increased proficiency with vascular ultrasound examination should be

    demonstrated.

    4. Teaching of the above objectives to medical students and junior

    residents should be increasingly emphasized. After your OB

    Ultrasound elective, you should give a one hour lecture on any specific

    OB US topic to our department when Dr. Gates or Dr. Heldmann is

    present.

5. Increased attention to MSK US with Dr. Simoncini.

    Interpersonal and Communication Skills

    FIRST YEAR RESIDENTS (PGY-2):

    1. Work to structure your dictated reports of imaging studies to accurately

    and effectively transmit results and recommendations to referring

    clinicians.

    2. Work with attending staff to develop techniques for effective oral communication with patients, referring clinicians, and support personnel in radiology. Demonstrate skills in obtaining informed consent, including effective communication to patients of the procedure, alternatives, and possible complications

3. Demonstrate appropriate phone communication skills and

    documentation in the dictated report of the name of the

    physician/clinician notified of any significant unexpected or potentially

    serious findings.

    4. Work with technologist as required, to answer questions proposed. Go

    in on studies requested.

    SECOND AND THIRD YEAR RESIDENTS (PGY-3 or 4):

    1. All of the objectives listed for first year residents should be reviewed

    with increased mastery.

    2. Demonstrate increasing skill in clearly and concisely communicating

    via the radiology dictated report.

    3. Demonstrate a leadership role in communications/interactions with

    technical personnel and patients, including explanation of delays

    related to emergencies.

    4. Demonstration of the knowledge/behavior associated with these

    objectives should be evident in teaching to medical students and junior

    residents.

    5. Direct real time exams, modify as needed. Cooperate with

    technologists, complete exams as needed.

    FOURTH YEAR RESIDENTS (PGY-5):

    1. All of the objectives listed for first, second, and third year residents

    should be reviewed with increased mastery.

    2. Demonstrate increased ability to communicate effectively with

    providers at all levels of the health care system as well as those in

    outside agencies, etc.

    3. The senior resident should model by action as well as directly teach

    the above objectives to referring clinicians, technical personnel,

    medical students and junior residents.

    Professionalism

    FIRST YEAR RESIDENTS (PGY-2):

     1. Demonstrate compassion, honesty and ability to provide care/interact

    with others without regard to religion, ethnic, sexual, or educational

    differences and without employing sexual or other types of harassment.

     2. Demonstrate understanding of the principles of patient confidentiality

    by compliance with the HIPAA Privacy Rule.

    3. Demonstrate completion of medical records, including review/signoff

    of radiology reports, according to departmental/hospital guidelines.

    4. Demonstrate positive work habits, including punctuality and

    professional appearance.

    5. Demonstrate honesty with patients and all members of the health care

    team.

6. Cooperate with technical personnel as needed.

    SECOND AND THIRD YEAR RESIDENTS (PGY-3 or 4):

    1. All of the objectives listed for first year residents should be reviewed

    with increased mastery.

    2. Demonstrate altruism (putting the interests of patients and others

    above own self-interest).

    3. The resident should teach the above objectives to medical students

    and junior residents directly as well as by modeling behavior consistent

    with these objectives.

    FOURTH YEAR RESIDENTS (PGY-5):

    1. All of the objectives listed for first, second, and third year residents

    should be reviewed with increased mastery.

    2. The senior resident should increasingly supervise and mentor medical

    students and junior residents in achieving these objectives.

    Practice-Based Learning and Improvement

    FIRST YEAR RESIDENTS (PGY-2):

    1. Analyze practice experience and perform practice-based improvement

    in cognitive knowledge, observational skills, formulating a synthesis

    and impression, and procedural skills. Demonstrate this by active

    review and performance modification and active participation in

    morbidity and mortality/ misses conferences.

    2. Participate in Journal club, clinical conferences, and independent

     learning

     3. Active participation in ultrasound audit and QC

    4. Demonstrate use of multiple sources, including information

    technology, to optimize life long learning and support patient care

    decisions.

SECOND AND THIRD YEAR RESIDENTS (PGY-3 or 4):

    1. All of the objectives listed for first year residents should be reviewed

    with increased mastery.

    2. Residents should demonstrate that they are reading the current

    literature, particularly the Radiology and the American Journal of

    Roentgenology, by being familiar with material recently published in

    those journals. A life-long pattern of reading these journals should be

    begun.

     3.Other Journals specific to US include AIUM and JCU.

FOURTH YEAR RESIDENTS (PGY-5):

    1. All of the objectives listed for first, second, and third year residents

    should be reviewed with increased mastery.

    2. Demonstrate awareness of resources available to practicing

    radiologists for lifelong learning, including print, CD-ROM, and internet

    products of the ACR.

    3. Demonstrate knowledge of the above objectives by supervision of

    medical students and junior residents as well as by directly teaching

    these objectives.

    Systems-Based Practice

FIRST YEAR RESIDENTS (PGY-2):

    1. Begin to acquire knowledge regarding the costs of imaging studies and

    impact of costs on appropriate choices for clinical use.

    SECOND AND THIRD YEAR RESIDENTS (PGY-3 or 4):

    1. All of the objectives listed for first year residents should be reviewed

    with increased mastery.

    2. Demonstrate the ability to design cost-effective imaging strategies/care

    plans based on knowledge of best practices.

    3. Demonstrate knowledge of hospital-based systems that effect

    physician practice, including physician code of ethics, medical staff

    bylaws, quality assurance committees, and credentialing processes.

    This includes knowledge of how these processes may affect the scope

    of practice of any one physician and competition among practitioners.

    FOURTH YEAR RESIDENTS (PGY-5):

    1. All of the objectives listed for first, second, and third year residents

    should be reviewed with increased mastery.

    2. Demonstrate knowledge of how decisions about the timing/availability

    of imaging studies may affect hospital length of stay, referral patterns

    for specific examinations and use of diagnostic studies outside the

    Department of Radiology.

    3. Demonstrate knowledge of the regulatory environment. Demonstrate

    knowledge of basic management principles such as budgeting, record

    keeping, medical records, and the recruitment, hiring, supervision and

    management of staff.

     nd1. Middleton WD, Kurtz AB, Hertzberg BS. Ultrasound: The Requisites (2

    Edition), Mosby, 2004.

    On first rotation, read the following first: Chapter 1 (Practical Physics), Chapter 2 (Gallbladder), Chapter 3 (Liver), Chapter 4 (Bile Ducts), Chapter 5 (Kidney), Chapter 9 (General Abdomen), Chapter 22 (Pelvis and Uterus), Chapter 23 (Adnexa), and Chapter 14 (The First Trimester and Ectopic Pregancy). If possible, read Chapter 6(Lower GU), Chapter 7 (Pancreas), Chapter 8 (Spleen), Chapter 11 (Extremities)

    On second rotation, review the chapters listed above, and read Chapter 10 (Neck and Chest) and Chapters 12-21 (Obstetrical Ultrasound).

Report this document

For any questions or suggestions please email
cust-service@docsford.com